Heterotopic Ossification after Elbow Arthroscopy: An Underreported Outcome
Jessica M Intravia, MD, MHA1; Daniel P Acevedo, MD2; Joanie J Chung, MPH, MA2; Raffy Mirzayan, MD2; (1)University of Southern California, Los Angeles, CA, (2)Kaiser Permanente, Baldwin Park, CA
Introduction: There are few large studies documenting the complications of elbow arthroscopy, especially one representative of the community orthopaedic surgeon. Frequently, surgeons counsel their patients on the risk of nerve palsy, however the rate of postoperative heterotopic ossification requiring additional procedures may be an under recognized complication.
Methods: After IRB approval, 560 consecutive elbow arthroscopies in 528 patients performed between 2006 and 2014, by 42 surgeons at 13 facilities were reviewed. There were 114 pediatric cases and 446 adult cases. Of note, one high volume surgeon performed 202 arthroscopies and regularly obtains a postoperative XR to examine for heterotopic ossification. These XRs were also reviewed for any additional cases of heterotopic ossification not documented in the clinical chart.
Patient demographics, BMI, smoking status, medical co-morbidities, tourniquet time, prior surgery, concomitant procedures, patient positioning, size of scope, complexity score, range of motion, and surgeon fellowship status were recorded.
Results: The average age was 38.6 years (range: 5-88). There were 444 males. The average length of follow up was 375.8 days (0-2739 days). Overall, heterotopic ossification occurred in 13 of 559 (2.3%) cases. For the single surgeon subset with regular screening, heterotopic ossification occurred in 8 of 202 cases (3.9%) with seven (3.4 %) requiring repeat surgery. This is significantly higher than the 1.7% rate of heterotopic ossification found in the remainder of the cohort. Average preoperative range of motion was 82.6 degrees postop 86.5. Eight of the thirteen patients with post operative heterotopic ossification had a preoperative diagnosis of elbow contracture. With regards to heterotopic ossification, all cases occurred in male patients, but no other significant risk factors were identified.
Conclusions: Elbow arthroscopy remains a safe procedure with very low complication rates. Certain patients are at risk for developing post-operative heterotopic ossification which could necessitate an additional surgery. Surgeons should be aware of this complication so that they may counsel their patients appropriately.
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